=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437837721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REACHING HANDS BEHAVIORAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2023
-----------------------------------------------------
Last Update Date | 07/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 LAKE SHADOW CIR APT 10303
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-7586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-203-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 LAKE SHADOW CIR APT 10303
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-7586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-203-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SANDRINE N AMEGNISSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-203-9018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------